Fungal Infection Flashcards
What issue / Tx
1) Occurs most commonly in intertriginous areas such as the axillae, groin, digital web spaces, glans penis, and beneath the breasts. Vulvovaginal candidiasis is common among women.
2) Intertriginous infections manifest as pruritic, well demarcated, erythematous patches of varying size and shape; erythema may be difficult to detect in darker skinned patients.
3) Primary patches may have adjacent satellite papules and pustules; the contents of which dissect horizontally under the stratum corneum and then peel it away.
–(1)Results in a red, denuded, glistening surface with a long, cigarette paper-like, scaling and advancing border.
Candidiasis
Treatment
(1)Affected skin should be kept dry and exposed to air as much as possible.
(2)Topical Azole class antifungals:
–(a)Miconazole (Monistat)
–(b)Clotrimazole (Lotrimin-AF)
–(c)Ketoconazole (Nizoral)
(3) Allylamine class antifungals:
–(a)Terbinafine (Lamisil)
–(b)Relief is almost immediate, but treatment should be continued for 10 days.
True/False
Topical steroid preparations give temporary relief by suppressing inflammation and is recommended for candidiasis.
FALSE
eruption rebounds and worsens. These preparations are NOT recommended!
Candidiasis & Fungal infectionc Risk Factors
-Hormonal alterations of the skin microbiome
-Elimination of competing microorganisms
-Physical environment changes
-Direct/Indirect Immunosuppression
Superficial fungal infections of the skin/scalp; various forms of dermatophytosis; the names relate to the particular area affected.
(a) ______: Infection of crural fold and gluteal cleft.
(b) ______: Infection involving the face, trunk, and/or extremities; often presents with ring-shaped lesions, hence the misnomer ringworm.
(c) _______: Infection of the scalp and hair; affected areas of the scalp can show characteristic black dots resulting from broken hairs
a) Tinea Cruris
b) Tinea Corporis
c) Tinea Capitis
Tinea
_______ can subsist on protein, namely keratin and can cause disease in keratin- rich structures such as skin, nails, and hair.
Dermatophytes
What issue/ Tx
(a) Scaling, round or oval pruritic plaques characterized by a sharply defined annular pattern with peripheral activity and central clearing (ring-shaped lesions).
(b) Papules and occasionally pustules/vesicles present at border and, less commonly, incenter.
(c) Pruritus may or may not be present.
Tinea Capitis
Treatment
(a) Topical
–1)Superficial lesions respond to antifungal creams.
–2)Clotrimazole, Miconazole or Terbinafine applied BID for a minimum of 2weeks.
–3)Continue treatment for at least 1 week after resolution of the infection.
–4)Extensive lesions or those with red papules require oral therapy.
(b) Oral
–1) Griseofulvin (ultra-microsize) 250 po mg QD x 2 weeks or Fluconazole 150 mg once a week for 3-4 weeks.
–2) Secondary bacterial infections are treated with oral antibiotics.
What issue/Tx
(a) Well-marginated, erythematous, half-moon-shaped plaques in crural folds that spread to medial thighs; advancing border is well defined, often with fine scaling and sometimes vesicular eruptions.
(b) Lesions are usually bilateral and do not include scrotum/penis (unlike with Candida infections).
(c) May migrate to perineum, perianal area, and gluteal cleft and onto the buttocks in chronic/progressive cases.
(d) The area may be hyperpigmented on resolution.
Tinea Cruris
Treatment
a) Fist-Line:
–1) Topical antifungal cream (terbinafine, miconazole, clotrimazole, ketoconazole)applied 2 times a day for 10 to 14 days.
–2) Absorbent powders (+/- antifungals) help to control moisture and prevent re- infection.
(b) Refractory, inflammatory or widespread infections:
–1) Itraconazole 200 mg orally once a day or terbinafine 250 mg orally once a day for 3 to 6 weeks may be needed in patients who have.
–2) Resume topical antifungal cream once symptoms are controlled.
Tinea Pedis
(a) May progress to fissuring or maceration in toe web spaces.
(b) Symptoms include itching, burning, and stinging of interdigital webs and plantar surfaces. Pain may indicate secondary infection.
(c) Most often presenting with asymptomatic scaling.
(d) May present with the classic “ringworm” pattern, but most infections are found in toe webs or on the soles.
(e) May progress to fissuring or maceration in toe web spaces.
(f) Wood lamp exam will not fluoresce unless complicated by another fungus, which is uncommon.
Tinea Pedis
Treatment
(a) Open-toed sandals when possible.
(b) Wear shower shoes in showers.
(c) Dry between toes after showering and frequent sock changing.
(d) Absorbent, non-synthetic socks preferred (Cotton).
(e) Antifungal powders.
(f) Recurrence is prevented by wearing wider shoes and expanding the web space.
(g) Powders are used to absorb excess moisture
(h) Topical Treatment
–1)Topical medications applied BID for 2-4 weeks. (Clotrimazole, Miconazole, Terbinafine)
(i) Oral Treatment
–1) For extensive/acute infections consider oral antifungals. May be started in combination with topical antifungal agents.
–2) When cleared by oral rx, begin maintenance therapy with topical antifungals as recurrence is common.
–3) Secondary bacterial infection is treated with oral antibiotics (common in heavily macerated lesions).
What issue / Tx
Presentation
(a) Velvety tan, pink or white macules that do not tan.
(b) Color is uniform in each person but may vary between people.
(c) Fine scales that are not visible but are seen by scraping the lesion.
(d) Central upper back, chest, and proximal arms (same areas as the highestconcentration of sebum).
(e) Typically asymptomatic, but a few patients note itching when overheated.
(f) Appearance is often the patient’s major concern.
Tinea Versicolor
Treatment
(a) Topical
–1) Topical treatment is indicated for limited disease.
–2) Selenium Sulfide 2.5% applied from neck to waist wash off after 5-15 minutes, repeat daily x 7 days. Repeat weekly x 1 month, then monthly for maintenance.
3) Ketoconazole 2% shampoo chest and back, wash off after 5 minutes. Repeat weekly.
(b) Oral
-1) Oral treatment is used for patients with extensive disease and those who do not respond to topical treatment.
-2) Cure rates may be greater than 90%.
–a) Ketoconazole 400 mg in a single dose with exercise to point of sweating after ingestion. Single dose is not always effective.
—b) Fluconazole 300 mg (2 capsules weekly x 2 weeks) has similar efficacy.
–3) Oral Terbinafine is not effective for this condition.
True/False
Oral Terbinafine is not effective for Tinea versicolor
True
Labs/Studies/Imaging Tinea Versicolor
(a) _____ KOH; fungal culture is not useful.
(b) Wood’s lamp shows _____-pigmented areas of infection.
(c) Wood’s lamp will show faint _____ fluorescence/pigment changes determine extent of the disease.
a) Positive
b) hypo
c) yellow-green
Tinea Versicolor
Overview
(a) Caused by ___________, which is part of the normal skin flora.
(b) Organism is nourished by ______; converts from yeast form to mycelial form and causes the disorder.
(c) Excess __________ predispose to infection.
–1)Very common especially in tropical or semi- tropical regions. Prevalence can reach 50%
–2)Male = female
(d) (NOT/IS) linked to poor hygiene
a) Pityrosporum orbiculare
b) sebum
c) heat and humidity
d) not
